An online quiz suggests that concern about fire or burglary in your home or catching a disease could be signs of Obsessive Compulsive Disorder (OCD). Though some attention to detail is perfectly reasonable and even necessary to avoid misfortune, the quiz also includes questions about ritualized washing and repetition of routine actions like turning off lights, locking doors, etc. — things that might not be quite so reasonable.
So, where does attention to detail leave off, and OCD begin? Is it obsessive to regularly wash your hands so you won’t get sick? Is it obsessive to check your email every hour? Is it compulsive to wait for the toilet tank to fill? Do you worry about the oven being on — every time you leave home? Let’s face it: All of us have our little tics and fixations. Whether it involves our personal space or our workplace, we usually feel most comfortable when things are “in order.”
The need for tidiness and organization is often a need for control, and this is not necessarily a bad thing. Those of you who read this column regularly know that I equate control with confidence and self-responsibility. Without it, the path leading to our goals and happiness can be blocked by unnecessary obstacles.
Over the years, I’ve seen many people whose need for control has become an impediment to the basic routines of their everyday lives. Their compulsions and phobias are sometimes so devastating that they can’t even leave the house, much less drive, shop or interact socially.
The Obsessive Compulsive Foundation (www.ocfoundation.org) defines OCD as a neurobiological (physical) problem, as opposed to a psychological (mental) one. But they also acknowledge that no genetic or other link to physiology has yet been established. Whatever the cause, all obsessions involve out-of-control thoughts or impulses to do certain things over and over again. Compulsions are the actions that OCD people take in order to reduce their anxiety over these thoughts and impulses. The actions don’t make sense, and the person with OCD fully understands this, yet he or she feels compelled to perform them anyway.
You don’t have OCD simply because you wash your hands more than average or take extra care to make sure the table is set properly for guests. OCD is a time-eater. Repetitive rituals reinforce the obsessive thoughts; the obsessive thoughts generate more ritualistic behaviors, giving rise to a vicious psychological cycle. A person without OCD might check the lock a second time after leaving the house, and at that point the anxiety is largely over. Conversely, a person with OCD checks the lock — over and over — but the anxiety doesn’t go away. He or she might spend an hour in the bathroom washing and rewashing. Years ago I worked with a woman who had to be admitted to the hospital because she had literally washed the skin off her hands and arms. She knew what she was doing, but she did it anyway.
It’s important to understand that there is no literal cure for OCD by taking medication or going to therapy. However, therapy can be crucial for helping to manage the problem. With persistence, the intrusive thoughts and impulsive actions can go into remission for periods of time. However, even people who feel they are cured will sometimes experience some reawakening of their symptoms during times of severe stress. Research suggests that some antidepressant medications can help by controlling the neurotransmitter known as serotonin, but research has also shown that just controlling serotonin is not enough. Behavioral and cognitive strategies, with guidance from a skilled psychotherapist, can go a long way toward bringing relief.
One of life’s challenges is to take risks, and we need to be aware of what’s happening around us in order to ensure our safety. But this awareness cannot be allowed to run amok. So we keep life interesting and tread a middle ground between risk and safety; all the while keeping a watchful eye on our behaviors and our psychological health.
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